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Florida rates for HCPCS C5277

Application of low cost skin substitute graft to face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits, total wound surface area greater than or equal to 100 sq cm; first 100 sq cm wound surface area, or 1% of body area of infants and children

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$789.00 / $4,299.00 / $11,550.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$532.17 / $532.17 / $532.17
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$322.70 / $327.23 / $389.56
Florida Blue
Facility/Professional
Facility
Modifier
Low / Median / High Price
$437.33 / $466.48 / $504.38
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$366.00 / $1,950.00 / $4,970.00
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.00 / $16.00 / $16.00